Provider Demographics
NPI:1164823035
Name:COLEMAN, CANDICE LESLIE (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:LESLIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3130 TOM AUSTIN HWY STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4519
Mailing Address - Country:US
Mailing Address - Phone:901-361-4116
Mailing Address - Fax:
Practice Address - Street 1:3130 TOM AUSTIN HWY STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4519
Practice Address - Country:US
Practice Address - Phone:901-361-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN98151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics